Grille détaillée des 25 critères du modèle IPS (y compris l’échelle de conformité)
SUPPORTED EMPLOYMENT FIDELITY SCALE*
1/7/08
Rater: Site: Date: Total Score:
Directions: Circle one anchor number for each criterion.
Criterion Data Anchor
Source**
Staffing
1. Caseload size: Employment specialists MIS, 1= Ratio of 41 or more clients per employment specialist.
have individual employment caseloads. The DOC, INT
maximum caseload for any full-time employment 2= Ratio of 31-40 clients per employment specialist.
specialist is 20 or fewer clients.
3= Ratio of 26-30 clients per employment specialist.
4= Ratio of 21-25 clients per employment specialist.
5= Ratio of 20 or fewer clients per employment specialist.
2. Employment services staff: Employment MIS, DOC 1= Employment specialists provide employment services specialists provide only employment INT less than 60% of the time.
services.
2= Employment specialists provide employment services 60 - 74% of the time.
3= Employment specialists provide employment services 75 - 89% of the time.
4= Employment specialists provide employment services 90 - 95% of the time.
5= Employment specialists provide employment services 96% or more of the time.
3. Vocational generalists: Each employment MIS, DOC, 1= Employment specialist only provides vocational referral specialist carries out all phases of employment INT, OBS service to vendors and other programs.
service, including intake, engagement, assessment,
job placement, job coaching, and follow-along 2= Employment specialist maintains caseload but refers clients supports before step down to less intensive employment to other programs for vocational services.
support from another MH practitioner. (Note: It is not
expected that each employment specialist will provide 3= Employment specialist provides one to four phases of the employment benefits counseling to their clients. Referrals to a highly service (e.g. intake, engagement, assessment, job development, job trained benefits counselor are in keeping with high placement, job coaching, and follow along supports).
fidelity, see Item # 1 in “Services”.)
4= Employment specialist provides five phases of employment service but not the entire service.
5= Employment specialist carries out all six phases of employment service (e.g. program intake, engagement, assessment, job
development/job placement, job coaching, and follow-along supports).
ORGANIZATION
1. Integration of rehabilitation with mental health MIS, DOC, 1= Employment specialists are part of a vocational program that functions treatment thru team assignment: Employment INT, OBS separately from the mental health treatment.
specialists are part of up to 2 mental health treatment
teams from which at least 90% of the employment 2= Employment specialists are attached to three or more mental health
specialist’s caseload is comprised. treatment teams. OR Clients are served by individual mental health practitioners who are not organized into teams. OR Employment specialists are attached to one or two teams from which less than 50% of the employment specialist’s caseload is comprised.
3= Employment specialists are attached to one or two mental health
treatment teams, from which at least 50 - 74% of the employment specialist’s caseload is comprised.
4= Employment specialists are attached to one or two mental health
treatment teams, from which at least 75 - 89% of the employment specialist’s caseload is comprised.
5= Employment specialists are attached to one or two mental health
treatment teams, from which 90 - 100% of the employment specialist’s caseload is comprised.
2. Integration of rehabilitation with mental health MIS, DOC 1= One or none is present.
treatment thru frequent team member contact: INT, OBS
Employment specialists actively participate in 2= Two are present weekly mental health treatment team meetings (not
replaced by administrative meetings) that discuss 3= Three are present.
individual clients and their employment goals with
shared decision-making. Employment specialist’s office 4= Four are present.
is in close proximity to (or shared with) their mental
health treatment team members. Documentation of 5= Five are present.
mental health treatment and employment services is
integrated in a single client chart. Employment specialists All five key components are present.
help the team think about employment for people who
haven’t yet been referred to supported employment • Employment specialist attends weekly mental health treatment team meetings.
services.
• Employment specialist participates actively in treatment team meetings with shared decision-making.
• Employment services documentation (i.e., vocational assessment/profile, employment plan, progress notes) is integrated into client’s mental health treatment record.
• Employment specialist’s office is in close proximity to (or shared with) their mental health treatment team members.
• Employment specialist helps the team think about employment for people who haven’t yet been referred to supported employment services.
3. Collaboration between employment specialists DOC, INT 1= Employment specialists and VR counselors have client-related contacts and Vocational Rehabilitation counselors: The OBS, ISP (phone, e-mail, in person) less than quarterly to discuss shared
employment specialists and VR counselors have frequent clients and referrals. OR Employment specialists and VR counselors contact for the purpose of discussing shared clients do not communicate.
and identifying potential referrals.
2= Employment specialists and VR counselors have client-related contacts (phone, e-mail, in person) at least quarterly to discuss shared clients and referrals.
3= Employment specialists and VR counselors have client-related contacts (phone, e-mail, in-person) monthly to discuss shared clients and referrals.
4= Employment specialists and VR counselors have scheduled, face-to-face
meetings at least quarterly, OR have client-related contacts (phone, e-mail, in person) weekly to discuss shared clients and referrals.
5= Employment specialists and VR counselors have scheduled, face-to-
face meetings at least monthly and have client-related contacts (phone, e-mail, in person) weekly to discuss shared clients and referrals.
4. Vocational unit: At least 2 full-time employment MIS, INT, 1= Employment specialists are not part of a vocational unit.
specialists and a team leader comprise the OBS
employment unit. They have weekly client-based 2= Employment specialists have the same supervisor but do
group supervision following the supported employment not meet as a group. They do not provide back-up services for each other’s model in which strategies are identified and job leads caseload.
are shared. They provide coverage for each other’s
caseload when needed. 3= Employment specialists have the same supervisor and discuss clients
between each other on a weekly basis. They provide back-up services for each other’s caseloads as needed. OR, If a program is in a rural area where employment specialists are geographically separate with one employment specialist at each site, the employment specialists meet 2-3 times monthly with their supervisor by teleconference.
4= At least 2 employment specialists and a team leader form an employment unit with 2-3 regularly scheduled meetings per month for client-based group supervision in which strategies are identified and job leads are shared and discuss clients between each other. They provide coverage for each other’s caseloads when needed. OR, If a program is in a rural area where employment specialists are geographically separate with one employment specialist at each site, the employment specialists meet 2-3 times per month with their supervisor in person or by teleconference and mental health practitioners are available to help the employment specialist with activities such as taking someone to work or picking up job applications.
5= At least 2 full-time employment specialists and a team leader form an employment unit with weekly client-based group supervision based on the supported employment model in which strategies are identified and job leads are shared. They provide coverage for each other’s caseloads when needed.
5. Role of employment supervisor: Supported MIS, INT, 1= One or none is present.
employment unit is led by a supported employment DOC, OBS
team leader. Employment specialists’ skills are 2= Two are present.
developed and improved through outcome-based
supervision. All five key roles of the employment 3= Three are present.
supervisor are present.
4= Four are present.
5= Five are present.
Five key roles of the employment supervisor:
• One full-time equivalent (FTE) supervisor is responsible for no more than 10 employment specialists. The supervisor does not have other supervisory
responsibilities. (Program leaders supervising fewer than ten employment specialists may spend a percentage of time on other supervisory activities on a prorated basis.
For example, an employment supervisor responsible for 4 employment specialists may be devoted to SE supervision half time.)
• Supervisor conducts weekly supported employment supervision designed to review client situations and identify new strategies and ideas to help clients in their work lives.
• Supervisor communicates with mental health treatment team leaders to ensure that services are integrated, to problem solve programmatic issues (such as referral process, or transfer of follow-along to mental health workers) and to be a champion for the value of work. Attends a meeting for each mental health treatment team on a quarterly basis.
• Supervisor accompanies employment specialists, who are new or having difficulty with job development, in the field monthly to improve skills by observing, modeling, and giving feedback on skills, e.g., meeting employers for job development.
• Supervisor reviews current client outcomes with employment specialists and sets goals to improve program performance at least quarterly.
6. Zero exclusion criteria: All clients interested in DOC, INT 1= There is a formal policy to exclude clients due to lack of job readiness working have access to supported employment OBS (e.g., substance abuse, history of violence, low level of functioning, etc.) services regardless of job readiness factors, substance by employment staff, case managers, or other practitioners.
abuse, symptoms, history of violent behavior,
cognition impairments, treatment non-adherence, and 2= Most clients are unable to access supported employment services due to personal presentation. These apply during supported perceived lack of job readiness (e.g., substance abuse, history of violence, low employment services too. Employment specialists offer level of functioning, etc.).
to help with another job when one has ended,
regardless of the reason that the job ended or number 3= Some clients are unable to access supported employment services due to of jobs held. If VR has screening criteria, the mental perceived lack of job readiness (e.g., substance abuse, history of violence, low health agency does not use them to exclude anybody. level of functioning, etc.).
Clients are not screened out formally or informally.
4= No evidence of exclusion, formal or informal. Referrals are not solicited by a wide variety of sources. Employment specialists offer to help with another job when one has ended, regardless of the reason that the job ended or number of jobs held.
5= All clients interested in working have access to supported employment services.
Mental health practitioners encourage clients to consider employment, and referrals for supported employment are solicited by many sources. Employment specialists offer to help with another job when one has ended, regardless of the reason that the job ended or number of jobs held.
7. Agency focus on competitive employment: DOC, INT, 1= One or none is present.
Agency promotes competitive work through multiple OBS
strategies. Agency intake includes questions 2= Two are present.
about interest in employment. Agency displays written
postings (e.g., brochures, bulletin boards, posters) 3= Three are present.
about employment and supported employment services.
The focus should be with the agency programs that 4= Four are present.
provide services to adults with severe mental illness.
Agency supports ways for clients to share work stories 5= Five are present.
with other clients and staff. Agency measures rate of
competitive employment and shares this information with Agency promotes competitive work through multiple strategies:
agency leadership and staff.
• Agency intake includes questions about interest in employment.
• Agency includes questions about interest in employment on all annual (or semi- annual) assessment or treatment plan reviews.
• Agency displays written postings (e.g., brochures, bulletin boards, posters) about working and supported employment services, in lobby and other waiting areas.
• Agency supports ways for clients to share work stories with other clients and staff (e.g., agency-wide employment recognition events, in-service training, peer support groups, agency newsletter articles, invited speakers at client treatment groups, etc.) at least twice a year.
• Agency measures rate of competitive employment on at least a quarterly basis and shares outcomes with agency leadership and staff.
8. Executive team support for SE: Agency executive DOC, INT, 1= One is present.
team members (e.g., CEO/Executive Director, Chief OBS
Operating Officer, QA Director, Chief Financial Officer, 2= Two are present.
Clinical Director, Medical Director, Human Resource
Director) assist with supported employment 3= Three are present.
implementation and sustainability. All five key
components of executive team support are present. 4= Four are present.
5= Five are present.
• Executive Director and Clinical Director demonstrate knowledge regarding the principles of evidence-based supported employment.
• Agency QA process includes an explicit review of the SE program, or components of the program, at least every 6 months through the use of the Supported
Employment Fidelity Scale or until achieving high fidelity, and at least yearly thereafter. Agency QA process uses the results of the fidelity assessment to improve SE implementation and sustainability.
• At least one member of the executive team actively participates at SE leadership team meetings (steering committee meetings) that occur at least every six months for high fidelity programs and at least quarterly for programs that have not yet achieved high fidelity. Steering committee is defined as a diverse group of stakeholders charged with reviewing fidelity, program implementation, and the service delivery system. Committee develops written action plans aimed at developing or sustaining high fidelity services.
• The agency CEO/Executive Director communicates how SE services support the mission of the agency and articulates clear and specific goals for SE and/or competitive employment to all agency staff during the first six months and at least annually (i.e., SE kickoff, all-agency meetings, agency newsletters, etc.). This item is not delegated to another administrator.
• SE program leader shares information about EBP barriers and facilitators with the executive team (including the CEO) at least twice each year. The executive team helps the program leader identify and implement solutions to barriers.
SERVICES
1. Work incentives planning: All clients are offered assistance DOC, INT 1= Work incentives planning is not readily available or easily accessible to most in obtaining comprehensive, individualized work OBS, ISP clients served by the agency.
incentives planning before starting a new job and assistance
accessing work incentives planning thereafter when making 2= Employment specialist gives client contact information about decisions about changes in work hours and pay. Work where to access information about work incentives planning.
incentives planning includes SSA benefits, medical benefits,
medication subsidies, housing subsidies, food stamps, spouse and 3= Employment specialist discusses with each client changes in benefits based on dependent children benefits, past job retirement benefits and any work status.
other source of income. Clients are provided information
and assistance about reporting earnings to SSA, housing 4= Employment specialist or other MH practitioner offer clients assistance in programs, VA programs, etc., depending on the person’s obtaining comprehensive, individualized work incentives planning by a person
benefits. trained in work incentives planning prior to client starting a job.
5= Employment specialist or other MH practitioner offer clients assistance in obtaining comprehensive, individualized work incentives planning by a specially trained work incentives planner prior to starting a job. They also facilitate access to work incentives planning when clients need to make decisions about changes in work hours and pay. Clients are provided
information and assistance about reporting earnings to SSA, housing programs, etc., depending on the person’s benefits.
2. Disclosure: Employment specialists provide DOC, INT 1= None is present.
clients with accurate information and assist with OBS
evaluating their choices to make an informed 2= One is present.
decision regarding what is revealed to the employer
about having a disability. 3= Two are present.
4= Three are present.
5= Four are present.
• Employment specialists do not require all clients to disclose their psychiatric disability at the work site in order to receive services.
• Employment specialists offer to discuss with clients the possible costs and benefits (pros and cons) of disclosure at the work site in advance of clients disclosing at the work site. Employment specialists describe how disclosure relates to requesting accommodations and the employment specialist’s role communicating with the employer.
• Employment specialists discuss specific information to be disclosed (e.g., disclose receiving mental health treatment, or presence of a psychiatric disability, or difficulty with anxiety, or unemployed for a period of time, etc.) and offers examples of what could be said to employers.
• Employment specialists discuss disclosure on more than one occasion (e.g., if clients have not found employment after two months or if clients report difficulties on the job.)
3. Ongoing, work-based vocational assessment: DOC, INT, 1= Vocational evaluation is conducted prior to job placement with Initial vocational assessment occurs over 2-3 OBS, ISP emphasis on office-based assessments, standardized tests, intelligence
sessions and is updated with information tests, work samples.
from work experiences in competitive jobs. A
vocational profile form that includes information 2= Vocational assessment may occur through a stepwise approach that about preferences, experiences, skills, current includes: prevocational work experiences (e.g., work units in a day adjustment, strengths, personal contacts, etc, is updated with program), volunteer jobs, or set aside jobs (e.g., NISH jobs agency-run each new job experience. Aims at problem solving using businesses, sheltered workshop jobs, affirmative businesses, enclaves).
environmental assessments and consideration of reasonable
accommodations. Sources of information include 3= Employment specialists assist clients in finding competitive jobs directly the client, treatment team, clinical records, and with without systematically reviewing interests, experiences, strengths,
the client’s permission, from family members and etc. and do not routinely analyze job loss (or job problems) for lessons
previous employers. learned.
4= Initial vocational assessment occurs over 2-3 sessions in which interests
and strengths are explored. Employment specialists help clients learn from each job experience and also work with the treatment team to analyze job loss, job problems and job successes. They do not document these lessons learned in the vocational profile, OR The vocational profile is not updated on a regular basis.
5= Initial vocational assessment occurs over 2-3 sessions and information is documented on a vocational profile form that includes preferences, experiences, skills, current adjustment, strengths, personal contacts, etc. The vocational profile form is used to identify job types and work environments. It is updated with each new job experience. Aims at problem solving using environmental assessments and consideration of reasonable accommodations. Sources of information include the client, treatment team, clinical records, and with the client’s permission, from family members and previous employers. Employment specialists help clients learn from each job experience and also work with the treatment team to analyze job loss, job problems and job successes.
4. Rapid job search for competitive job: Initial DOC, INT, 1= First face-to-face contact with an employer by the client or the employment employment assessment and first face-to-face OBS, ISP specialist about a competitive job is on average 271 days or more (> 9 mos.) employer contact by the client or the employment after program entry.
specialist about a competitive job occurs within
30 days (one month) after program entry. 2= First face-to-face contact with an employer by the client or the employment specialist about a competitive job is on average between 151 and 270 days (5-9 mos.) after program entry.
3= First face-to-face contact with an employer by the client or the employment specialist about a competitive job is on average between 61 and 150 days (2-5 mos.) after program entry.
4= First face-to-face contact with an employer by the client or the employment specialist about a competitive job is on average between 31 and 60 days (1-2 mos.) after program entry.
5= The program tracks employer contacts and the first face-to-face contact with an employer by the client or the employment specialist about a competitive job is on average within 30 days (one month) after program entry.
5. Individualized job search: Employment specialists DOC, INT 1= Less than 25% of employer contacts by the employment specialist are based on
5. Individualized job search: Employment specialists DOC, INT 1= Less than 25% of employer contacts by the employment specialist are based on